NAMS Releases 2022 Guidelines for Hormone Therapy

Hormone therapy remains the most effective treatment for hot flashes and genitourinary syndrome of menopause.

Hormone therapy remains the most effective treatment for hot flashes and genitourinary syndrome of menopause, according to the 2022 Hormone Therapy Position Statement released by the North American Menopause Society (NAMS). 1

“Since our last Position Statement on hormone therapy published in 2017, there have been important additions that further clarify the balance of risks and benefits of hormone therapy options for menopause symptoms,” said Stephanie S. Faubion, MD, MBA, NAMS medical director and lead of the Position Statement Advisory Panel. 2 After exhaustive research and review of the literature over the past 5 years, “we have found that what hasn’t changed is that hormone therapy remains the most effective treatment for vasomotor symptoms [VMS] and the genitourinary syndrome of menopause [GSM] and has been shown to prevent bone loss and fracture.”

The position statement noted that personalization of treatment with shared decision-making with patients remains key, “with periodic reevaluation to determine an individual woman’s benefit-risk profile; with recommendations for the use of the appropriate dose, duration, regimen; and route of administration required to manage a woman’s symptoms and to meet treatment goals,” noted a press release from NAMS.

Additional highlights of the position statement include:

• Risk stratification should be done by age and time since menopause
• Transdermal routes of administration and lower doses of hormone therapy may decrease risk of venous thromboembolism and stroke
• Low-dose vaginal estrogen therapy for treatment of GSM appears safe and effective for select survivors of breast and endometrial cancer.
• Breast cancer risk does not increase appreciably with short-term use of estrogen-progestogen therapy and may be decreased with estrogen alone.
• Compounded bioidentical hormone therapy presents safety concerns and is not recommended.
• For women with GSM, vaginal estrogen (and systemic if required) or other nonestrogen therapies may be used at any age and for extended duration, if needed.

Benefits vs Risks of Hormone Therapy During Menopause

According to NAMS, “the benefits of hormone therapy outweigh the risks for most healthy symptomatic women who are aged younger than 60 years and within 10 years of menopause onset.” For women with primary ovarian insufficiency and premature or early menopause who are at higher risk of bone loss, heart disease, and cognitive or affective disorders, “hormone therapy can be used until at least the mean age of menopause unless there is a contraindication to its use.”

How Long to Continue Hormones

Hormone therapy does not need to be routinely discontinued in women older than 60 or 65 years and can be continued beyond age 65 for management of persistent VMS or for prevention of osteoporosis, noted NAMS. However, patients need to be appropriately evaluated and counseled on the benefits and risks of long-term hormone therapy.

“There is a paucity of randomized, controlled trial data about the risks of extended duration of hormone therapy in women aged older than 60 or 65 years, although observational studies suggest a potential rare risk of breast cancer with increased duration of hormone therapy,” noted the press release.

A patient-education piece, “Deciding About Hormone Therapy Use,” is part of the NAMS MenoNote series. This handout simplifies the data in the new NAMS Position Statement for women trying to make decisions about using hormone therapy.

Sources

1. North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Accessed July 7, 2022. https://www.menopause.org/publications/professional-publications/position-statements-other-reports

2. The North American Menopause Society. The North American Menopause Society releases its 2022 hormone therapy position statement. Press release. Accessed July 7, 2022.